Dr. Stamenov, Dr. Kairyakova and Prof. Hadzhidekova Presented at the 26th National Congress of BASRH

On 5 April 2025, Dr. Georgi Stamenov and Dr. Mila Kairyakova delivered a joint plenary lecture on “Oncology and Fertility” at the 26th National Congress of the Bulgarian Association for Sterility and Reproductive Health (BASRH). Although the scientific session in which the topic was presented focused on innovations in reproductive medicine, for our team this is far from a new subject.

Dr. Stamenov shared key lessons and insights gained from nearly twenty years of experience in the field of oncofertility. With great emotion, he spoke about the challenges that cancer repeatedly presents, particularly in children and young adults. Modern cancer treatments are becoming increasingly successful, giving patients the chance to overcome the disease, while at the same time placing their future fertility at risk.

Although international recommendations for fertility preservation in cancer patients have existed for years, we still encounter cases in Bulgaria where patients have not only missed consultation with a reproductive specialist but have even been discouraged by their treating physicians, being led to believe that pursuing fertility preservation would compromise their chances of survival.

It is important for both patients and healthcare professionals to understand that there are proven, safe methods for fertility preservation. More importantly, preserving the possibility of future parenthood plays a significant role in treatment adherence, as scientific evidence shows that concerns about fertility loss are among the leading reasons why young women discontinue their cancer therapy.

Dr. Stamenov discussed the challenges posed by the still limited awareness of oncofertility among oncologists, gynaecologic oncologists, reproductive specialists, and patients themselves. He highlighted our long-standing efforts to improve awareness and stressed that education is the key to every individual case. Success depends on honest and open communication between patients, parents, oncologists, pathologists, geneticists, and reproductive specialists.

He emphasised that successful oncofertility care requires a multidisciplinary team, excellent communication, and state-of-the-art facilities for long-term cryopreservation of reproductive material. In his words, “We do not simply preserve eggs and sperm; we hold the souls of these people in our hands.”

Dr. Stamenov also shared our experience in fertility-sparing surgery, an area that remains underutilised in Bulgaria despite its critical importance for cancer survivors wishing to become parents. He presented our achievements in implementing advanced surgical techniques, including trachelectomy (removal of the cervix while preserving the uterus in early-stage disease), uterine and ovarian transposition, hysteroscopic treatment of endometrial cancer, fertility-preserving management of ovarian cancer, ovarian tissue transplantation, and more than 100 successful cases of hormonal haemostasis in patients with oncohaematological diseases, enabling subsequent fertility preservation.

Another group of patients in whom oncology and reproduction intersect are women diagnosed with cancer during pregnancy. Thanks to the multidisciplinary approach successfully implemented at Nadezhda Hospital, we are increasingly able to provide treatment strategies that maximise the chances for both mother and baby.

Dr. Stamenov stressed that whenever cancer and reproduction intersect, decisions should not be made solely by the medical team. Instead, they should be made together with the patient—and the parents when the patient is a child—based on complete and honest information, respect for personal wishes, empathy, and a commitment to providing the best possible care before, during, and long after treatment.

Following Dr. Stamenov’s presentation, Dr. Mila Kairyakova delivered her lecture entitled “Oncology and Fertility – Choosing to Preserve Dreams.” She presented a series of compelling clinical cases encountered throughout the years. Alongside successful outcomes, she also discussed cases in which the desired result was not achievable because patients were referred only after receiving gonadotoxic cancer treatment or because of specific medical circumstances.

The diversity of cases and practical lessons presented by Dr. Stamenov and Dr. Kairyakova reflected the wide range of scenarios they encounter daily. Their presentation served as a reminder that even the most advanced medical technologies have limitations, but that timely information can empower patients to make decisions that offer the greatest chance of both survival and quality of life.

The topic generated significant interest among congress delegates. During the lively discussion that followed, numerous practical questions were raised, giving Dr. Stamenov and Dr. Kairyakova the opportunity to share details about the protocols and methods they use, as well as their scientific rationale.

Prof. Dr. Savina Hadzhidekova, Head of the Genetics Laboratory at Nadezhda Hospital and Chair of the Department of Medical Genetics at Sofia Medical University, also participated in the congress.

Prof. Hadzhidekova presented the topic “PGT for Hereditary Breast Cancer – Can and Should We Break the Chain?” Preimplantation genetic testing (PGT) provides an opportunity to identify a range of genetic abnormalities in embryos before transfer. Beyond this, however, PGT has the potential to prevent hereditary cancer syndromes by interrupting the transmission of cancer-predisposing mutations to future generations.

This innovative application of genetic testing was the focus of Prof. Hadzhidekova’s presentation. She shared a successful case from our clinical practice involving a patient who had undergone cancer treatment and was a confirmed carrier of a BRCA1 mutation. Following PGT, only embryos without the high-risk mutation were selected for transfer. The result was the birth of a healthy baby girl, while the hereditary transmission of the mutation was successfully prevented.

We would like to thank the congress organisers for the opportunity to share our extensive experience in the field of oncofertility. The many raised hands during the discussion demonstrated that the topic is increasingly recognised as important and relevant among reproductive medicine specialists in Bulgaria. At the same time, it highlighted the need for further dialogue and deeper discussions so that more colleagues may join us in advancing this important cause.